How your doctor treats your pseudogout will depend on whether it's acute or chronic. Learn which treatments can reduce pain and inflammation and help with long-term disease control.

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Like gout, pseudogout is caused by the formation of painful crystals in the joints, most often in the lower extremeties. But in gout these crystals are made of uric acid, while in pseudogout they are made of calcium pyrophosphate. Pseudogout is also known as calcium pyrophosphate deposition disease (CPDD), and can resemble other forms of chronic arthritis, including rheumatoid arthritis, when it involves many joints.

Although pseudogout is not generally as destructive as gout, untreated pseudogout can eventually lead to severe joint degeneration in some people. “The only way to tell the difference between gout and pseudogout,” says Calvin Brown, MD, a professor of medicine in the division of rheumatology at Northwestern University in Chicago, “is for a trained physician to take some fluid out of the involved joint and to look at it under a microscope.” Uric acid crystals and calcium pyrophosphate crystals look different under a microscope.

Treating an Acute Pseudogout Attack

Andrew Wong, MD, chief of rheumatology and program director at UCLA Medical Center, says that patients are initially treated with NSAIDs (non-steroidal anti-inflammatory drugs) such as ibuprofen during an acute attack. “If you feel it coming on, you can start the NSAID right away and actually avoid the attack as the joint doesn’t swell up,” explains Dr. Wong.

NSAIDs can irritate the stomach lining, so they are not advised for people with peptic ulcer disease, and are usually only prescribed with another medication to protect the stomach. NSAIDs can also have some cardiovascular side effects, and may adversely affect those with heart failure. People who have any type of rheumatic disease should make sure to inform their rheumatologist.

If a person has a pseudogout attack in only one joint or cannot be treated with NSAIDs, a local corticosteroid injection into the joint may be used to directly decrease inflammation.

Corticosteroids are potent anti-inflammatory agents. Long-term effects include hypertension, hyperglycemia, and neuropsychiatric problems, so they are most often used only intermittently for short periods.

Treating Pseudogout: Long-Term Drug Therapy

Since scientists have yet to discover the cause of the formation of calcium pyrophosphate, there are no preventive treatments for pseudogout. “It’s not related to diet in the body," says Dr. Brown. “Unfortunately, we don’t know where calcium pyrophosphate comes from.”

However, the one therapy that may help lessen the severity and decrease the frequency of pseudogout is the drug colchicine. Colchicine does not harm the stomach like an NSAID; however, most people will have some temporary gastrointestinal side effects including nausea, vomiting, and diarrhea.

Even though it may cause some stomach upset, Wong says, “In pseudogout, we try and encourage colchicine’s use a bit more, despite side effects, because we are limited as to the different medication armature that we can use.”

Treating Pseudogout: Other Long-Term Therapy

“Physical trauma to the joint or to another part of the body, overuse, and even stress may trigger pseudogout to flare up,” says Wong. “So we teach people how to learn to live with their condition.” This includes knowing the warning signs of an attack, taking prophylactic NSAIDs, being careful not to injure the affected joint, maintaining a healthy body weight, and learning to manage stress levels.

For those for whom pseudogout progresses and causes joint damage, surgery can help repair and replace damaged joints. According to the Arthritis Foundation, surgery can clean away damaged cartilage, replace badly damaged joints with artificial ones, fuse the joint to relieve pain, and repair deformities.

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